Our heart needs a lot of care we are told, but what of the body’s largest solid organ that lies below it? Union minister for science and technology Vilasrao Deshmukh is being treated at a Chennai hospital for multiple liver conditions — it’s time to pay heed to our own.
The multi-tasking organ performs several functions: it metabolises fats and carbohydrates, eliminates toxins, synthesises protein and secretes bile to aid digestion. All of these are vital to our well being. Yet, says Dr Rakesh Rai, a liver transplant surgeon at Fortis Hospital, it’s tough to know when things aren’t right with the liver.
Late detection is common
|In cirrhosis, the liver becomes pock-marked and shrunken. It is a progressive disease that has to be monitored once in six months to rule out tumour formation
Rai says liver diseases have subtle symptoms that a patient almost always misses. “Typical symptoms are generic — fatigue, weakness, anaemia, fluid collection in the legs and tummy, and drowsiness. The only way to detect a liver disease is when you chance upon it during a health check up.
That’s why they are rarely diagnosed in time.” But the price we pay for late detection is high. Major liver complications include cirrhosis, acute hepatitis A, B, C and E, chronic hepatitis B and C, liver tumour and cancer. In India, more than 2 lakh people die of liver diseases every year, according to data published by the World Health Organisation, in April 2011.
Alcohol isn't sole cause
Dr Sanjay Nagral, consultant liver surgeon at Jaslok Hospital says, “In cirrhosis, which is the final phase of chronic liver disease, functionality declines and the liver becomes pock-marked and shrunken. Usually, cirrhosis is diagnosed at a late stage. It is a progressive disease that has to be monitored once in six months to rule out formation of tumours.
Many patients resort to alternative medication, which only worsens the situation.” Cirrhosis, contrary to popular belief, isn’t just a result of alcohol abuse, but can also be caused by hepatitis B, C and D or due to a fatty liver.
Non alcoholic-fatty liver disease (NAFLD) is linked to obesity, unhealthy food habits, a sedentary lifestyle and diabetes. So, one way to avoid cirrhosis, even if you don’t drink, is to make sure you lead a healthier lifestyle.
“The solution is similar to the one for preventing heart disease. Eat healthy, exercise and shun junk food,” says Nagral. Doctors also recommend cirrhosis patients to go off salt since excess of it leads to water retention.
What about Hepatitis?
The sharp rise in hepatitis B and C cases is mostly because of incorrect hospital practice, such as the casual use of unsterilised hospital equipment, including injection needles, feels Nagral. “As a nation, we are hooked on to injections.
We believe it’s a cure for every ailment. As a result, a lot of hepatitis infections get easy access to our bodies. Also, practice safe sex since hepatitis B and C are transferred through body fluids,” he cautions.
Binge drinking harms liver, too
“Drinking from an early age is now common and nobody believes in moderation. We have had bizarre cases of 16-year-old boys with alcohol-related cirrhosis. The youth need to be told to quit or cut down, because once cirrhosis sets in, there is no treatment left other than a liver transplant,” says Rai.
Alcohol targets the liver (causing cirrhosis) and the pancreas (causing pancreatitis), but it rarely targets both at once. Both conditions, if not treated in time, are fatal.
When transplant is necessary
Doctors first advise patients to cut down on alcohol — better late than never works with a little luck on your side. The good news is that the liver has the terrific ability to regenerate and restore its functions. “Of the 200 patients we evaluated for liver transplant last year, about 10 cirrhosis patients who were on the waiting list for surgery quit alcohol.
Six months later, they didn’t need a transplant, as their livers had regenerated,” says Nagral. Liver transplant is an expensive option, and meant for those who haven’t responded to cutting back on alcohol and medication.
Non-availability of donors is also a problem that faces patients, as red-tapeism is for those who wish to donate. Nagral says, “At Rs 12 to Rs 14 lakh, a liver transplant is not as unaffordable as it used to be. However, the wait for the donor may be long.”
How alcohol wreaks havoc on the liver
While your body takes time to digest what you eat, it metabolises alcohol more rapidly. A small percentage of the alcohol can reach the brain within close to a minute.
Once the alcohol lands in your stomach, it enters the bloodstream through the stomach wall. The liver produces alcohol- converting enzymes like Alcohol Dehydrogenase (ADH). Most of the alcohol consumed is metabolised in the liver, but the small quantity that remains unmetabolised permits alcohol to be measured in the urine and breath.
When the liver is asked to handle more alcohol than it can, the unmetabolised alcohol rushes out into the organs. The more you consume, the more it circulates in your body.
This puts pressure on the liver and damages its cells in the long run. Damaged liver cells cannot metabolise fats effectively, and soon, fat begins to accumulate in the liver, instead of spreading across the body, and getting utilised as it should be. This fat storage leads to a ‘fatty liver’, which compounds the problem.